Endometriosis is much more easily managed surgically in its early stages. To wait until you've got deposits all over the place (liver, bowel, peritoneum, bladder) before you have surgery puts you in a much worse position. The peritoneal and organ stripping ops we do for severe endometriosis are brutal and I've seen one death as a result of complications.

Get it sorted early, it's really not worth the wait over management and admin frustrations.

There's three things they continually miss out on though. Firstly is pilots strictly regulated hours and rotas. If pilots were having to work the length of shifts and weekly hours I work then they'd be forced to be grounded in order to have enough rest time.
The second is that the pilot is only responsible for the plane they're currently flying. They're not trying to fly to Mexico whilst fielding endless interruptions from other pilots going on different routes or from people asking about how long their turn around will be before they take off again.
Finally is the "no blame" reporting system. If someone fucks up big time and they report it within a certain time frame then they're guaranteed not to be "blamed" but it's used as a learning exercise to ensure that similar mistakes can be prevented or minimised in the future. If I fuck up big time I'm subjected to a deep dive into my handling of the case, blame will be apportioned where it can and I'm potentially up for either an expensive civil case or even a manslaughter charge regardless of the system I was working in at the time.

Our local CCG is pushing on, against massive local opposition, first to close the local A+E dept then the entire local hospital, replacing it with a "planned care centre" (out-patients and day-case surgery only) and relying on the PFI hospital in the next town to deal with everything else.

So far this year, GP practices have twice been sent faxes to say that the hospitals are struggling to cope with demand, and only to admit patients as emergencies if essential. (whenever I get a fax like that, I am tempted to reply and demand that they let us know when it is OK for us to admit emergency patients when it is not essential.)

Of course, this is on a background of cutcaks particualrly to social care, but also to mental health and community services. A friend of mine has just had an emergency admission after his condition deteriorated while waiting for investigations and out-patients. Actually, in his case, I cannot think of any time in my medical career when he would have got other things done in time to avoid the emergency admission, but I see many other cases where an emergency admission could have reasonably been avoided had it not been for delays in more planned approaches.

Worked there as a gas SHO in 2010. Even back then there was no way in hell that Calderdale could cope with the extra volume of work that Hudds would generate. We were doing the work of a trauma receiving hospital (despite the Level 1 being down the motorway) as well as acute vascular take as well as the general sugical/plastics/paeds acute take as well. Coupled with the ICU, maternity and pain service it left the OOH anaesthetic cover (SHO plus middle grade) stretched very thinly. Transplant that lot into calderdale who also was providing an acutes service, maternity service and ED cover and you've a recipe for disaster.

Pinderfields have just merged with Dewsbury and the work load strain has been mental. From what I've heard they're ignoring the CEPOD safety rules and doing simple abscesses at 3am just to get through the work load. The ICU team can barely keep on top of the workload and maternity is swamped despite them doubling the theatre availability and moving elective sections off the unit.

With demand increasing such that it is closing beds and rationalising services over such a large area can in no way lead to better care. You're just spreading existing resources even more thinly, exhausting the staff and ensuring nobody wants to work there. You couldn't even find a parking space at Calderdale after 8am and that's before moving another 1000 staff.

Having said all that though I did like the canteen at Halifax more even if it was part of the (no doubt evil) ISS mediclean chain.

It will depend on the type of valve replacement he's getting. If he's going to need ITU post op then I'd say he's probably going to get delayed. Locally we've not had an empty ITU or HDU bed since New Years Day and we're cancelling all surgery requiring ITU/HDU that's not an acute case, a cancer case or a transplant case. It's getting so bad they're starting to think about stopping transplants.

Our Cardiac ITU is full of non-cardiac cases (mainly influenza) alongside the super urgent cardiac cases (emergency revascularisation etc). Same story with neuro ITU although they do tend to have a higher number of cancer cases.

The basic story is that the Flu season has hit us hard (mainly influenza A (aussie) and Influenza B) but we're starting to see a fair handful of really sick Swine flu patients.
Influenza A is really knocking off anyone with preexisting lung disease (asthma, COPD) and we're getting deaths as a result despite our best efforts. It's compounded by the need to isolate these patients and we ran out of side rooms long ago. The wards are having to cohort all flu cases into "flu bays" so even if you discharge someone from a flu bay you can't just stick anyone in there as they'll likely get infected too.

The system is on the brink of collapse. I thought it was bad last year but this year has been much worse. We've not even hit our busiest period yet which traditionally is the week of the 11th January.

New years day I was running our large ITU, we had one bed, no discharges and in the first three hours of work I'd had 8 referrals and notice of a transplant underway which would take our last bed. I left the ward round and didn't get back to the unit for 8 hours, trying to help stabilise the referrals to keep them on the ward whilst looking after 3 people I had to intubate and put in theatre recovery (which then shut down the acute theatre as there were no nurses to recover the patients). I'm on again this weekend and I'm absolutely dreading it.

Still, nice to hear from our glorious leader the health secretary that there's no crisis and everything has been well planned for.
If this isn't a system in crisis then I honestly don't know what one looks like.

Oh, mate. If I could I'd make you a cup of tea, I couldn't do what you do. Thank you so much for such a comprehensive reply- I think he probably would be ITU afterwards, if anyone would be. He's a big, cirrhotic, diabetic old-before-his-time lad held together with everything the NHS can chuck at him, bless his heart. All his own fault, but alcohol is a bastard and the army is not the place for addictive personalities and already broken little boys. I am constantly humbled and overjoyed that you guys continue to keep him going.

Although one person's thanks makes sod all difference, thanks for persevering. My mum left the NHS last year, she couldn't watch it happen from within any more. So yeah, good luck and well done, top person.

Yeah it's inspired by real people and there was kind of a kerfluffle about it a couple of years ago as people figured out who the song was about by looking over the not-very-long list of rich Greek students enrolled in the sculpture course at St. Martin's while Jarvis Cocker was there.

I wouldn't have it done to me, I wouldn't have it done to a loved one (outside some very specific scenarios). It's brutal, it's indecent and it rarely works. When it does work you're often left with a body with a heartbeat that you know is going to die on ICU three days later. The vast majority of my colleagues feel the same way.

Sadly TV gives us the idea it's very sanitised and a quick shock from a defib will have you sitting up in bed talking to your loved ones in the next scene. They fail to mention the broken ribs, the punctured lungs, the ruptured liver, inhaling your own vomit and having multiple needles stuck in you at your time of passing.

Give me a DNACPR, an infusion of morphine, get my family and loved ones around me and let me go peacefully.

I've had several patients of Pakistani heritage refuse to have me treat them being a white man. I suspect someone refusing a BAME medic would get treated a lot more harshly than these patients refusing my care were.

In our trust the PACS system is being replaced, along with 8 other inbuilt systems in favour of a One-System-For-All which is being built by a Private Company who's charging £50million for development, then a £10million a year running fee. They also demand extra, similarly high payments for any updates that the trust wants to the system.

Before the decision for this was taken, our Development team showed the board of directors a working prototype of the exact same system, which they built within 3 months with the team of 3 here.

They said no to that, chose to take the Private system based of a slideshow presentation (none of their system was created) and we're now in a phase where the system has been delayed twice, it's currently 8 months over it's expected due date and the contract with the Trust is so poor that it included no clauses for late fees so the trust has paid £50million and is now paying £14million for a system which isn't on time, does half of the functions which are currently available (Wards will have to switch from electronic patient tracking boards to WHITEBOARDS AND PENS because the functionality will not be available), requires more time to do every task currently possible and has the most awful UI design I think I've ever seen in a piece of software.

I've honestly thought about it, though I'm the only new starter in our Department, I feel there's a good chance it would come back around to being me that's spoken out and there goes my job.

I try and be politically vocal, it's all I feel I can do. And even if I spoke out as much as I would feel justice in having the project investigated, It'd still go ahead, as too much money has been invested at this point.

I've heard neighboring trusts to us are using the same company for similar systems, I'm absolutely sure there's been some high-level under the table cash handed as it seems very strange that there is a single Private company absorbing all these extortionately priced projects with absolutely no motivation from the Trusts to investigate cheaper options. Even when that cost is quite literally 99.95% cheaper.

I did a lot of media for the BMA during the juniors strike last year. Obviously I made a few contacts in the UK specialist press alongside some TV and Radio stations.

If you want to do it anonymously I'd be happy to act as a go between and can arrange it such that you'd never be identified (Hell if I don't know who you are then how can anyone else?". People like Phil Hammond and Shaun Lintern know how important confidentiality can be and will respect it - especially if they're getting a good juicy story out of it.

If you want to get the details leaked then PM me and I'll start sniffing around and seeing if anyone would be interested in running it. If not I totally understand and hope you manage to persuade management to see some sense in the future!

But he died because he wasn't treated in time. It was the hour long wait that killed him; had he been seen earlier then it could have been avoided. His wait time was shorter than many would experience, however it clearly was too long to avoid his death.

No he died because he had a rare genetic disease that kills most children before the age of 5. Generally speaking if an hours wait is enough to kill you then your chances of survival are very poor to begin with.

As a gp registrar, phone and video consultations have inherently more risk than a face to face consult. This will impact medical indemnity which is already prohibitively expensive. It also increases the likelihood of a letter from the gmc. I'm not surprised GPs aren't massively fond of such things

How they can make a confident diagnosis without listening to a chest or palpating an abdomen I don't know. Even with the instant access to imaging and pathology that I have on ITU we always start with history and examination.

Yep, already happening. Covering ICU over the weekend - completely full with nurses doubling up level 3 patients. We had two ventilated in recovery and there were no beds in the region to transfer them to. ED had 21 patients waiting for beds and their time to see a doctor was 6 hours.

It's not even cold yet and the flu season hasn't hit. We've been on black alert twice during the summer and had all elective (and cancer) surgery cancelled for two weeks.

I'm covering critical care until February. I'm shit scared we're going to be put in a position where we have patients needing level 3 nursing care but with no beds and no staff to care for them. All it will take is a 30 minute delay in intubating an asthmatic or pneumonia and you've got a dead patient that could have easily survived.

Yeah that's fair enough if I was parking up to grab a bite at the cafe or was doing non emergency stuff. Also, I disagree in the one rule for them argument, if a member of the public had pulled over for a serious emergency, like they were having a serious medical problem, or somebody on the pavement was getting the shit kicked out them, or a fire was going on, or a terrorist threat was going down, they would not get a ticket for stopping on the yellows. And if an insane power man parking warden did issue a ticket, it would get thrown in immediately upon appeal.

Police on emergency response are exempt from stuff like double yellow parking aren't they? Just like using red signals as stop signs and driving at excess speed. AFAIK plod can only get in bother if they're not responding to an emergency otherwise they get statutory exemption from most of the road traffic act.

I've done a fair bit of HEMS work on ambulances ad we used to park wherever we could - the driver never really gave a shit as long as we were as close as possible. I'm not response driver trained but the paramedics gave me the impression that as long as they weren't going the wrong way down a one way street, driving in the wrong direction on a dual carriageway and a few other things they couldn't get in trouble.

There is a benefit. You get seen more quickly, you get your treatment more quickly, you are guaranteed to be attended to by a consultant (as opposed to his/her juniors in the NHS), nicer food, private room, better nurse:patient ratio, quieter environment, access to surgery/drugs not available on the Nash etc etc.

There are significant downsides though. The paucity of junior doctors means that in the event of a problem you'll be waiting for your consultant to be available if you need (for example) a return trip to theatre or have a significant deterioration overnight. There's no private ED care so you'll have to go through the NHS initially before being transferred. If you become seriously unwell you'll be transferred back to the NHS for ITU care and sometimes an ambulance journey when you're that poorly can make things worse.

There's also some reported issues with clinical governance within the private sector as hospitals don't want to admit failures in procedure or care due to reputation damage. There's also little oversight of consultants as they work in a bubble rather than in a team as they would in the public sector. This was recently highlighted as a breast surgeon has been jailed for performing hundreds of unnecessary private breast operations.

I work in the NHS and I've been an inpatient. My first admission for an acute orthopaedic problem was a fucking nightmare. A demented old man in the bed opposite me pissed on me at 3am thinking he'd walked to his bathroom (I couldn't escape as I'd broken a leg and was in traction). The bloke next to me was a Polish gentleman who worked in a chicken slaughterhouse and had mangled his hand. Unfortunately he came straight from work and absolutely stank of rotting meat and chicken shit. He refused to be washed and the stench was overpowering. If I'd been in a private hospital none of those problems would have happened and my stay would have been a lot more comfortable.

On the other hand when I got an infected screw it was recognised quickly, treatment was prompt (I'd had a registrar review within an hour of my observations deteriorating) and I was in theatre 4 hours later. That wouldn't have happened in the private sector.

If I require further surgery, and it's something production line routine (hip/knee replacement, arthroscopy etc) then I would seriously consider going private. If it was something major such as a coronary bypass or a whipple's or anything else with a large amount of risk attached I'd go nowhere near the private sector and stick with the NHS.

To be honest the DNA's (folks who missed appointments) were a bit of a relief as it gave me time to catch up if I was running late, write a referral to the hospital or even grab a quick cup of tea.

The failure I can see with fining people is that there will no doubt be payment exemptions for people who are under 18, unemployed, receiving benefits, pregnant, retired or with mobility issues. That's pretty much the entire GP cohort of patients. We mainly see old people, young mums, young and perimenopausal women, children and those with chronic disease. The only folks that will be paying the fines are people earning a good income who don't have long term health conditions and these people aren't usually the ones that miss the appointments to start with.

There is a podcast I listen to called Econtalk. The host recounted a story a number of years ago where a daycare or nursery instituted a fine on parents who were late to pick up their children, with the fine increasing every minute (or something similar). The result was that lateness increased, apparently because the morality/personal accountability had been removed from the dynamic, and the parents could then view it as an optional charge they could pay to come later.

Apart from not liking the idea on general principles, I wonder if such a system could have unintended consequences.

EDIT: Furthermore, I have recently had to wait 5 hours for a procedure which was then cancelled, rescheduled and then rescheduled again. I was not angry, there was higher than normal demand, it was not the doctor's fault. Perhaps there could have been better organisation but I'm sure they are trying - I gave the benefit of the doubt.

Now in the proposed situation would my hospital be paying a fine to me for disrupting my work scedule/lost income? Or paying a fine into the public purse as an incentive? I think something is lost when you lose the social aspect in these situations. I believe markets to be very powerful, but also believe we have social systems in place to deal with many situations where you are dealing with other people. I'm sure there is a problem with people missing appointments and stretching an already strained budget, but perhaps there are other solutions that would work better, barring good evidence.

I'm not sure about other procedures but "on day" cancellations of operations for non clinical reasons are tallied and if they exceed a certain percentage of cases the hospital pays a fine to the government.

There's also targets that must be hit with regards to GP referral to treatment, waiting times for cancer surgery, length of wait in ED before being admitted/discharged etc.

In the current climate these have all gone to pot due to lack of staffing and resources, but when labour were in and the money was there we were put under a lot of pressure by management to hit these targets to avoid the hospital paying these fines.

Oh god I'd forgotten all about Kro. Nice enough venue but a weird mix of people and all the black market fenced goods you could possibly want. If you wanted to finish off the night with pills or horse there were plenty of suppliers willing to help.

Although, to be fair I did once date a woman who had only previously had romantic relationships with women prior to us meeting. I don't like the phrase "turned" but she's since married a man and had a child with him.

Obviously she was bisexual rather than being a lesbian, but if you asked her at the time I imagine she'd have self-identified as being a lesbian. Human sexuality is a gloriously complex beast and I think definitive labels are at the extreme ends of the spectrum.

I'm straight, never found myself sexually attracted to a man ever. I'm quite aware though that it's not completely impossible that I meet a bloke who makes me rethink things. I can't ever see it happening, but that's the beauty of it - all sorts of unexpected surprises can turn up.

I just started my obgyn residency in July at a Catholic hospital (we can't prescribe contraception) in a very rough city. The biggest problems I see are
1. People having many many kids unintentionally because they aren't on BC, it's often but not always correlated with lack of prenatal care
2. People missing prenatal visits for logistic reasons, can't get off from work, nobody to watch the kids, can't afford the ultrasound (though we have excellent social workers who help with this stuff)
3. People showing up randomly in labor either having just stepped off a plane from the middle east or northern Africa (don't see it much from Latin America) with no prenatal care
4. People with a ton of other problems, morbid obesity and diabetes and preexisting hypertension getting c sections and then not healing properly because of their aforementioned illnesses.

Our hospital has the hemorrhage carts, they work fine. The program director reviews the reasoning behind first time c sections and sends letters to the performing docs as well as has monthly review meetings with the staff, it's been working slowly but surely. A lot of the push back comes from difficult to quantify factors suggesting against vaginal deliveries, everybody in the pt's family had unsuccessful labor and got a c section, mom has the epidural titrated properly and just isn't pushing very hard for whatever reason despite coaching from nurse and doctor, mom has a bunch of soft risk factors that culminate in their private physician keeping a low threshold for CS when baby's heart v tracing starts getting a little borderline rather than trying 5 times to restore it before going to the OR.

This doesn't apply so much to super diverse countries like the UK or wherever else, but because the US is such a melting pot, we commonly have 6ft European dads having kids with 5'2 ft Latino or Asian moms, mom's uterus wasn't made for that kid and so there's a higher risk of that baby having a compromised blood supply that leads to morbidity or a CS. That's compared to other countries like Ireland where Irish moms give birth to Irish babies with Irish dads that are an appropriate Irish size. There have been a number of Maternal Fetal Medicine (high risk pregnancies) debates on this kind of thing.

The other issue I see is that vaginal birth after cesarean sections VBACS aren't performed frequently enough. There's a small risk of uterine rupture involved that can be catastrophic when it does, in very rare cases, happen. It is not taken advantage of frequently enough because the consent forms necessary to attempt them take forever to talk through, which is made even worse because they usually need to be done over language translation phones which automatically triple the amount of time needed to finish them, all the while, mom is usually crying in pain because she's already contracting without anesthesia. Also, when you see one instance of those uterine ruptures happening, it spooks the entire department for several months at least, largely because nobody wants their patients to be hurt, and partly because quote "I have two kids, $300,000 in medical school loans, and malpractice insurance trying to make the former 2 even more difficult. Tell me why I want to even consider the chance of a uterine rupture".

All that is just off the cuff of a 4 month old OB/GYN resident's experience.

Edit; differing size of parents can convey increased RISK of cephalopelvic disproportion which leads to increased C section rate. If dad is 7 ft tall and mom is 4 ft tall with a tiny pelvis and a 7lb baby they very well may be fine but there is a higher CHANCE of needing a C section.

Edit #2: I mention Ireland because there were a series of publications back and forth between the US and Irish doctors discussing the different C section rates between countries, mentioning the different ethnic/size makeups of the countries with relation to the previous edit. If you are offended, pick a less offensive country to substitute for Ireland, I guess.

Our target LSCS rate is to aim below 20% and we're currently running around 22% (in a large teaching hospital with about 11k deliveries per year). We're in a deprived area with a lot of multi-comorbid patients - gestational diabetes, preeclampsia on top of essential hypertension, morbid obesity (personal record is getting an epidural in a woman with BMI of 65), low educational attainment and foetal abnormalities secondary to consanguineous relationships.

VBAC here is considered the default route for the next confinement. 2 x LSCS means you're booked for an elective section. Women are given a choice (and recently have been allowed to request an elective section for "maternal choice") however vaginal birth is pushed hard and elective surgery is only really done for breeches that have failed ECV, large baby, multiple previous sections, placenta praevia or major maternal health problems. As a result most of our sections are emergencies and they're usually foetal distress or failure to progress.

I guess the main difference is that whilst we carry malpractise insurance it's really only for clinically negligent care. We're covered by the hospital insurance for everything else so if a woman wanted to sue because she was talked into a vaginal birth but ended up with an emergency section a) it wouldn't go anywhere as long as the care wasn't negligent and b) we're not personally liable - I'm never going to have to pay out of my own bank account as the hospital and my insurance will carry the burden. The only time I'm personally at risk is if I do something so egregious that it's negligent and harm comes to the patient as a result (can be jailed for manslaughter, can be struck off from the register).

These protections mean we're able to do what's in the womans best interests rather than do necessarily what they demand be done. For instance I won't perform a General Anaesthetic for C Sections unless there's an overriding indication and I can simply refuse to offer one to someone who "would rather be asleep". Of course it might generate a complaint, however they can be handled by the trust and I don't have to worry about being sued.

A lot of that is related to panic and poor planning. You get an overdose, everyone freaks out, someone draws up a gallon of narcan and slams it IV. You now have a severely hypoxic patient that is instantly dope sick and in total confusion as 20 people are standing around them. You would flip the fuck out too.

Heroin (generally) isnt going to kill you. Its the respiratory depression that does people in. Slow down. Take 5 minutes to bag the patient, get some oxygen into their system, give them narcan IM or IN or titrate a drip. Go slow, ease them out of it. You'll almost always end up with your patient slowly waking up and reorienting vs the cluster fuck that is the panic stricken hypoxic patient jumping off the table to bash you.

Locally we give an IV and IM shot at the same time. The IV shot brings them round and the IM shot acts as a depo for the ones that run away. When we just gave them IV naloxone we sometimes found them collapsed in the car park again due to the lower half life naloxone allowing the diamorphine to reoccupy the receptors.

I mean, you get trained up in ANY other field, you are expected to work there for a set amount of time. An example would be accounting, where my employer pays for my tuition and exams.

I feel something similar in the NHS would be fairer. It costs crazy money to train a doctor: tax payers money too. Yes they work during it but it does not nearly cover the 200 odd k it costs to train them.

Edit: before this get deliberately misinterpreted, I am not, nor was the OP, suggesting indentured servitude. they are called training contracts. If you dont want to have 200k spend on your education, then dont sign up for the deal.

The 200k figure is mostly bollocks as it includes the salary a junior doctor is paid whilst they're working for the NHS. The actual costs of training medical students is half that at best and the current crop of students is paying around £50k in tuition fees alone.

Most of the clinical teaching is provided by other doctors, for free, either at the bedside or in lectures. We do this out of goodwill and it costs the universities and the trusts nothing as I still have to get the same amount of work done whether I've got students with me or not. There's no allowance made by giving me half a day off clinical duties to teach or by reducing the size of my list when I've got students with me.

I've regularly done 20 hours as the senior tube monkey in a tiny DGH. One anaesthetic SpR and one novice/SHO on. Bloke comes in needing to go to national cardiac or neuro centre and I got packed off with them regardless of the time of day (couldn't leave the next shift without senior cover, consultant on call can't leave hospital without senior support etc - the usual bollocks).

Land transfer from the Pennines to the Freeman in Newcastle is around 6 hours return including handover. Get back, quick shower, find an empty theatre to try and sleep in then get up and do it all again in the morning.

It was a nice hospital to work at but after 6 months of it I was ready to kill myself. God only knows the standard of anaesthesia I was delivering but thankfully most of the punters were low acuity day case stuff.